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Teens enter my office for many different reasons. Most times, parents initiate the contact. Other times, it’s schools. Adults’ concerns are usually—and correctly—about the teen’s safety. So, teens who have problems with self-injury, suicidal thoughts, and aggression are often identified and sent to someone like me. Other behaviors that prompt such action include defiance, oppositional behavior, school refusal, argumentative behavior, and social isolation.

And so treatment begins. And sometimes it’s brief. And more often it’s longer. And when their behavior is regulated, when teens are no longer self-injurying or suicidal, aggressive or using substances…we find the underlying problems. What’s underneath all this unsafe behavior? Would you guess…social anxiety? In my office, I’ve seen a higher-than-expected number of self-injurying teens who actually—before all the unsafe behaviors—had developed Social Anxiety Disorder. And they still have it. Because these kids can be outrageous in appearance and behavior, people often suppose they have similarly bold personalities. Not true.

These teens scowl because they feel as if they are in the glare of the public eye, and that the public is waiting to criticize them. They don’t scowl because they hate the system.

These teens break eye contact not because they don’t like you, but because looking you in the eye paralyzes them with a flood of adrenaline.

These teens end conversations quickly because they are over-analyzing the situation and struggle to think of what to say next. They don’t stop talking because they think you’re boring or stupid.

These teens prefer the company of one close friend—or of no one at all—not because they can’t stand people, but because they can’t stand how they feel around people. It’s miserable.

When I ask these teens how others describe them, one word keeps coming up: “Intimidating.” Their peers tell them that they are intimidating, that they don’t seem to like anyone, and that they are kind of scary. People assume these teens are irritable and that they are verbally or physically dangerous.

But they are none of these, really. They are consumed by a sometimes-panic level of anxiety when they are in social situations. So they’ve found ways to hide anxiety. Some dress in crazy fashions. Others isolate. Some use drugs to feel comfortable around others (this only makes anxiety worse down the road; it’s not a solution). Some teens act obnoxious and outrageous.

Of course, not all self-injurying teens have Social Anxiety Disorder. Many teens dress in crazy clothes because they just like them; they’re not hiding anything. And of course, teens can be obnoxious without any diagnostic label.

But take a look at yourself and your friends…could there be anxiety under all that behavior? If you fix the anxiety, you’ll be more effective. You won’t have to do those things that get you in trouble or draw negative attention. You’ll feel well, again. Like you did when you were a little kid.

First Law of (e)Motion: Every emotion tends to remain in that state of emotion, unless an external force is applied to it. If you want your emotion to change, you have to do something to change it. Or else, it stays the same.

A lot of teens tell me that when such-and-such happens, they’ll be happy. When they graduate. When the semester is over. When parents stop worrying about them. When they lose 10 pounds. And, actually, the teens are sort of right. These events act on emotions in a postive way. The problem is, the events don’t sustain happiness. What’s worse, they are often not within a teen’s control (how do you “make” parents stop worrying about you?).

You can apply external force to your emotions, all by yourself. You don’t have to wait for life to affect you. Just understand and follow the next couple laws of (e)Motion.

Second Law of (e)Motion: The relationship between feelings, ideas, and behaviors is (Feelings = Ideas x Behaviors). Your thoughts and behaviors create how you feel, even if you’re not trying to create any feelings.

Your ideas are in fact powerful messages to your physiology. They create neurochemical events that generate feelings. When you sit in class thinking, over and over: “This is so boring,” you are refiring the emotion of irritability. If you tell yourself how awkward you are at a party, you create anxiety. If you focus on all the things you “need” but don’t have (e.g., better clothes, better body, higher grades, cooler friends, nicer parents), you sustain sadness.

Behavior also plays a role in creating emotions.

For example, there is such a thing as “acting depressed.” This doesn’t mean faking depression. It means behaving in ways that are consistent with depression. Sleeping a lot. Over-eating. Not exercising. Seeking out sad movies/songs. Isolating yourself. Not showering. You’re depressed, so why bother, right?

There is such a thing as “acting anxious,” which is basically avoiding things that make you uncomfortable or nervous. So you don’t try out for the team. And you don’t tell your classmate to stop putting you down. You don’t go on the rollercoaster with your friends. And you don’t tell the Starbucks barista she messed up your $7 drink. You’re anxious, after all, and those things are pretty uncomfortable, right?

Irritability can be created by not getting enough sleep and by skipping meals. It can be sustained by stomping around the house complaining, giving mean looks to people around you, and trying to get through the day as quickly as possible. Irritability can be strengthened by procrastinating on homework you know you have to do, and by bickering with siblings. You’re grumpy, and it’s the world’s fault, right?

You don’t even have to try to create emotions. You’re already doing it. You probably do it most of the time. Like now, how are you feeling and what are you thinking/doing to sustain that feeling? If you want to create happiness, follow the Third Law of (e)Motion…

Third Law of (e)Motion: For every idea and behavior, there is an opposite and equal idea and behavior. When you act and think opposite to how you feel, you will change your feeling.

Emotions won’t hurt you. They can be unpleasant. So what: they don’t last forever! If you can successfully tolerate and manage your feelings in the moment, you’ve mastered the Laws of (e)Motions!

When we’re upset, we often think and act in ways that make things worse. The master of (e)Motion does this: act and think contrary to how you feel. Do the opposite thing. If you don’t feel like going to the gym…go to the gym! If you are afraid to ask for help…ask for help! If you are thinking about all your flaws…think about all the great things about you!

When you think and behave opposite to how you feel, you change your emotion. It really can be that simple. You are not at the mercy of your feelings. Apply force with your thoughts and behaviors, and start to feel better.

Stress is how you respond to “stressors.” And stressors are most of the things in your life: parents, grades, personal appearance, falling in love, friends, prom, teachers, jobs, clubs, college applications, break-ups, mid-terms. It can seem like stress is just a natural part of teen life.

People have different thresholds for stress. You probably know people who are quite happily busy for 18 hours a day. You also know folks who seem overwhelmed with just the idea of a to-do list. If you’re like most teens, you’re somewhere in the middle: working to balance the parts of your life, effectively. You are probably doing the best you can. And, still, you’re feeling stressed out.

Stress is a mean relative of anxiety. Anxiety has lots of relatives, and not all of them are bad. Many people who achieve at high levels have a drive to do well that can cause anxiety. So, goal-achievement is a nicer relative of anxiety. Conscientiousness—how aware we are of ourselves and others—is also related to normal anxiety: another nice relative. But, stress…he’s a mean one.

Stress is the unwanted, vague, suffocating, terrorizing relative that tends to overstay his welcome. When stress stays too long, it is bad for you. You’ve probably heard: chronic stress is associated with poor sleep, lowered immune deficiency, inflammation that damages your body’s cells, acne, high blood pressure, aches, weight gain, and gastrointestinal problems. Stress makes you feel inept. In a world of problems, it blocks every potential solution from your view. Like I said: mean.

So how do you manage stress effectively? Dialectal Behavior Therapy (DBT) would tell us to try reducing our emotional vulnerability. Use the P.L.E.A.S.E. skill. Stress really is in your body, not just in your mind. So, the first step in countering stress is to take care of your body. The P.L.E.A.S.E. skill is a guide for this. When your body is healthy, it’s better prepared to manage the daily stressors that are part of life. And, should a big stressor present itself (finals!), you’ll be ready to take them on, too.

P: Physical and L: HeaLth. (L fits, see?)Take care of your body. If you’re sick, treat the illness, first and foremost. Your body is telling you something: “take care of me.” So, rest. Take medications as prescribed by your doctor. These may be your vitamins, antibiotics, psychotropics, blood thinners, inhalers…whatever your doctor and parents both agree is right for you, take those medications as prescribed.

E: Eating. Balance your eating. Don’t eat too much. Don’t eat too little. Both can make you feel ridiculously tired. Over-and under-eating can cause clinically significant levels of inattention. They lead to moodiness, including especially irritability. Both over-eating and under-eating can become all-consuming, where the thing you think about most is food. That makes it hard to be effective in life.

Eat good foods. They really make a difference. Whole grains. Fruit and vegetables. Lots of water. If you love carbohydrates, try to move those into the evening hours. Your best concentration/energy foods are the proteins, and it’s a worthwhile goal to include a protein at every meal. Good protein sources are almonds, soybeans, cheese, milk, chicken, and energy bars. Sugars and fats aren’t just hanging out at the top of the food pyramid, they are wreaking havoc on your concentration and mood. So, avoid those. They taste good, but the cost on your effectiveness is just too high.

A: Altering. Avoid non-prescribed mood altering substances and behaviors. You got it—that means drugs. People who habitually and regularly use illegal substances have higher rates of depression, lower academic performance, lower relationship satisfaction, lower self-esteem, and fewer reasonable future goals. Mood-altering behaviors are usually dangerous, and unnecessarily so. Cutting yourself or otherwise harming yourself can be mood-altering. It can be mood-altering to drive 100mph down a country road. Such unsafe and impulsive behaviors do not reduce stress in the long-term. In fact, 9 times out of 10, they just end up making things worse for you.

S: Sleep. Sleep is like food for your brain. It is the time when today’s learning experiences consolidate and go into long-term storage (you may experience this as dreaming). That’s why people advise you to get a good night’s sleep before a test. Sleep is also when important neurochemicals and hormones are released to support your growth and brain functioning. Poor sleep leads to impaired concentration, zits, impulsivity, irritability, weight gain, and vulnerability to illness.

If you’re like many teens, sleep is the first thing you de-prioritize in your schedule. You may cut into sleep hours without a second thought. Like, staying up late to study, work, or (electronically) socialize. Some set early alarms to finish up a paper or get in a workout. If you take nothing else away from this article, take this: PROTECT YOUR SLEEP. Defend it. Honor it. You need it.

Teens need between 8-11 hours of sleep a night. If you can’t fit your obligations comfortably into the other 13-16 hours a day, then you’re doing too much. Barriers to sleep are more prevalent than you may know. Barrier #1 and #2: your cell phone and IPAD. Scientists have found that the LED screens in hand-held devices interfere with your brain functioning in ways that delay sleep onset. Barriers #2, #3, and #4: your TV, video games, and personal computer. While TV and video games do not have the LED component, they can be pretty tough to turn off when you’re tired at night. Take-home message is this: put your electronics to bed at least one hour before you’d like to be asleep.

E: Exercise. Just do it. Aim for a minimum of 3 workouts a week. Workouts should last at least 30 minutes, and they should get your heart really pumping. Working out with a friend is a fun way to stick to a regimen. With exercise, remember: the cart usually comes before the horse. Not many people “feel like” working out until they are well into their workout. If you wait around until you feel like exercising, it may never happen. But you’ll notice that, once you get started, the motivation to workout follows. If you’re having a lot of trouble with exercise, research shows that just taking a few minutes to visualize your workout can increase your motivation and readiness.

Stress is a normal part of life. But it can be really difficult to manage. If your struggles with stress are more intense, these are your warning signs:

• feeling sad/irritable more days than not, and for most of each day
• worrying about almost everything, like your mind can’t stop going
• needing more than one hour to fall asleep, or waking up a lot at night
• gaining/losing 10+ pounds in one month
• thoughts of death, suicide, or self-harm
• thoughts or plans to hurt others
• feeling hopeless, or like nothing matters
• changing your life goals drastically within the past month (e.g., “I don’t care if I graduate.”)
• headaches, stomachaches, or indigestion
• isolating yourself from friends
• feeling ineffective (pushed over) in relationships
• wondering, “what’s the point?” of taking care of yourself
If you have any of these signs, then the P.L.E.A.S.E . skill alone may not help much. You should talk to a mental health professional. Seek out your school support staff to see if therapy may be helpful for you.

The Centers for Disease Control reported recently that about 1 in 25 teenagers take antidepressant medications, writes the Huffington Post. Depressive episodes in adolescents can look different from adult depression. For one, teens tend to show more irritability than sadness. Another difference is that teens are not as adept as adults in articulating issues associated with depression. Teens who meet criteria for a diagnosis of depression also usually have at least 4 of the following symptoms: (1) loss of interest in activities that used to be pleasurable to them, (2) changes in appetite or weight–either increases or decreases, (3) sleep problems, including troubles falling or staying asleep, or sleeping too much, (4) seeming either physically slowed-down or physically agitated and restless, (5) feeling fatigued or out of energy often, (6) feelings of guilt or worthlessness, (7) problems concentrating or making decisions, (8) recurrent thoughts of death or suicide. Depression is more likely to affect females. It also runs in families. Children who have not yet reached puberty are more likely to have depression in conjunction with other disorders–such as ADHD, Anxiety, or Disruptive Behavior Disorders.

If you suspect a teenager you know may be depressed, you should take action. Schedule an evaluation with a child psychologist. There are evidence-based treatments for depression, most of which are based in cogntive-behavioral therapies. You should notice symptom improvement after 12-16 weeks of treatment. If improvement is slow or nil, consider making an appointment with a child psychiatrist to discuss medication that may be appropriate as an adjunct to therapy.